Provider Demographics
NPI:1083164388
Name:MORONTA, CHRISTINE MARGARET (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARGARET
Last Name:MORONTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:MARGARET
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:108-49 63 AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:347-865-2803
Mailing Address - Fax:
Practice Address - Street 1:108-49 63 AVE APT 2A
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:347-865-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307719-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health